CD34-selected hematopoietic stem cell transplants conditioned with myeloablative regimens and antithymocyte globulin for advanced myelodysplastic syndrome: Limited graft-versus-host disease without increased relapse Journal Article
| Authors: | Tamari, R.; Chung, S. S.; Papadopoulos, E. B.; Jakubowski, A. A.; Hilden, P.; Devlin, S. M.; Goldberg, J. D.; Perales, M. A.; Ponce, D. M.; Sauter, C. S.; Maloy, M. A.; Herman, D. Y.; Klimek, V.; Young, J. W.; O'Reilly, R. J.; Giralt, S. A.; Castro-Malaspina, H. |
| Article Title: | CD34-selected hematopoietic stem cell transplants conditioned with myeloablative regimens and antithymocyte globulin for advanced myelodysplastic syndrome: Limited graft-versus-host disease without increased relapse |
| Abstract: | Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative therapy for patients with myelodysplastic syndrome (MDS). Donor T cells are critical for the graft-versus-tumor effect but carry the risk of graft-versus-host disease (GVHD). CD34 selection with immunomagnetic beads has been an effective method of depleting alloreactive donor T cells from the peripheral blood graft and has been shown to result in significant reduction in acute and chronic GVHD. We analyzed the outcomes of 102 adults (median age, 57.6 years) with advanced MDS who received a CD34-selected allo-HSCT between January 1997 and April 2012 at Memorial Sloan Kettering Cancer Center. The cumulative incidences of grades II to IV acute GVHD were 9.8% at day 100 (95% confidence interval [CI], 5.0% to 16.5%) and 15.7% at day 180 (95% CI, 9.4% to 23.4%). The cumulative incidence of chronic GVHD at 1 year was 3.9% (95% CI, 1.3% to 9.0%). The cumulative incidences of relapse were 11.8% at 1 year (95% CI, 6.4% to 18.9%) and 15.7% at 2 years (95% CI, 9.4% to 23.4%). Forty-eight patients were alive with a median follow-up of 71.7 months. Rates of overall survival (OS) were 56.9% at 2 years (95% CI, 48% to 67.3%) and 49.3% at 5 years (95% CI, 40.4% to 60.2%). Rates of relapse-free survival (RFS) were 52.0% at 2 years (95% CI, 41.9% to 61.1%) and 47.6% at 5 years (95% CI, 37.5% to 56.9%). The cumulative incidences of nonrelapse mortality were 7.8% at day 100 (95% CI, 3.7% to 14.1%), 22.5% at 1 year (95% CI, 15.0% to 31.1%), and 33.4% at 5 years (95% CI, 24.2% to 42.6%) post-transplant. The incidence of chronic GVHD/RFS overlapped with RFS. These findings demonstrate that ex vivo T cell-depleted allo-HSCT by CD34 selection offers long-term OS and RFS with low incidences of acute and chronic GVHD and without an increased risk of relapse. © 2015 American Society for Blood and Marrow Transplantation. |
| Keywords: | adult; aged; middle aged; young adult; major clinical study; overall survival; busulfan; fludarabine; mortality; outcome assessment; follow up; t lymphocyte; cd34 antigen; morbidity; relapse; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; thiotepa; acute graft versus host disease; chronic graft versus host disease; myeloablative conditioning; myelodysplastic syndrome; cd34 selection; thymocyte antibody; recurrence free survival; unrelated donors; human; male; female; article; acute and chronic gvhd; advanced myelodysplastic syndromes; relapse/chronic gvhd-free survival |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 21 |
| Issue: | 12 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2015-12-01 |
| Start Page: | 2106 |
| End Page: | 2114 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2015.07.010 |
| PROVIDER: | scopus |
| PUBMED: | 26187863 |
| PMCID: | PMC4764129 |
| DOI/URL: | |
| Notes: | Export Date: 2 December 2015 -- Source: Scopus |
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